Health Information Management

Bill PTCA with modifier -74 for discontinued procedure

APCs Insider, December 2, 2005

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Bill PTCA with modifier -74 for discontinued procedure

QUESTION: A patient presents for a diagnostic left heart catheterization. While the patient is under conscious sedation, the physician finds an occlusion in the right coronary artery. At that time, the cardiologist decides to perform a percutaneous transluminal coronary angioplasty (PTCA), however he is unable to cross the lesion with the guidewire, so he terminates the procedure. Staff discharges the patient and schedules him for a coronary artery bypass graft.

How should our facility code the procedure? Can we code the PTCA with modifier -74, or are we only able to bill for the left heart catheterization because it was the only procedure the physician completed?

ANSWER: Bill for the PTCA since your facility used additional resources during the operation. Append modifier -74 to indicate that the procedure was discontinued. Conscious sedation is not normally considered "anesthesia," however, as of February 2005, CMS updated the definition of anesthesia to include moderate sedation and intravenous conscious sedation.

Report these procedures with modifier -74, which indicates that the procedure was already in progress before the physician discontinued it. The documentation should show the physician intended to perform the PTCA, and it should also show the attempts to cross the lesion (albeit unsuccessfully).

MedLearn Matters article MM3507 (published January 21, 2005) addresses this issue in detail. You can read it at the CMS Web site here:

Note that in the 2006 OPPS final rule CMS stated, "We will maintain our current policy of paying 100 percent of the APC payment for procedures reported with the -74 modifier for CY 2006. We agree with the commenters that, in general, the clinical circumstances where the -74 modifier is reported may be particularly diverse and unpredictable."

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